机器人手术系统在新生儿先天性肠旋转不良手术中的应用  

Robotic-assisted surgery in neonates with congenital intestinal malrotation

作　　者：王鹏[1] 黄寿奖[1] 吕成杰[1] 赖登明 赵晓霞[1] 胡书奇 马东 陈锐[1] 方舒 韩一江 钭金法[1] Wang Peng;Huang Soujiang;Lyu Chenjie;Lai Dengming;Zhao Xiaoxia;Hu Shuqi;Ma Dong;Chen Rui;Fang Shu;Hang Yijiang;Tou Jinfa(Department of Neonatal Surgery,Affiliated Children's Hospital,Zhejiang University School of Medicine,National Children's Health and Disease Clinical Medicine Research Center&National Children's Regional Medicine Center,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属儿童医院新生儿外科、国家儿童健康与疾病临床医学研究中心、国家儿童区域医疗中心,杭州310003

出　　处：《临床小儿外科杂志》2023年第9期876-880,共5页Journal of Clinical Pediatric Surgery

基　　金：浙江省基础公益研究计划项目(LY22H040006)

摘　　要：目的探讨机器人手术系统在新生儿先天性肠旋转不良手术中的应用价值及效果。方法回顾性分析2020年8月至2021年6月由浙江大学医学院附属儿童医院新生儿外科收治的15例经机器人辅助治疗的新生儿先天性肠旋转不良患儿临床资料、手术相关资料、术后恢复情况以及术后6~12个月的随访资料,分析患儿术前、术中以及预后情况,总结器人手术在肠旋转不良应用的相关经验。结果15例患儿中男13例,女2例;胎龄36^(+2)~40^(+4)周;早产儿2例,足月儿13例;剖腹产7例,顺产8例;手术时日龄(11.7±5.9)d;手术时体重(3065±377)g;7例术前超声检查提示肠扭转720°,5例术前B超提示肠扭转540°,3例术前B超提示肠扭转360°;12例胆汁性呕吐,3例非胆汁性呕吐;4例合并房间隔缺损,2例合并动脉导管未闭,2例合并室间隔缺损,其余7例未合并心脏畸形。15例均在机器人辅助下完成手术,无一例中转开腹。手术时间(57±8)min,装机时间为(14±3)min。术中气腹压力为(5.6±0.3)mmHg;呼气末PaCO_(2)为(38.4±4.3)mmHg,估计出血量1~3 mL。术后撤离呼吸机时间为(5.2±1.8)h。初次经口进食时间为术后(3.1±1.2)d,足量进食时间为术后(7.2±1.8)d,住院时间为(12.1±2.7)d。1例术后因局部肠粘连导致肠梗阻再次行手术治疗,1例因肠动力异常住院时间达27 d,其余13例恢复良好,无呕吐、腹胀、切口感染等术后并发症发生。出院后随访结果提示15例均喂养良好,手术切口愈合满意,生长发育正常。结论机器人手术系统在新生儿先天性肠旋转不良手术中应用安全、可行,可以取得良好的治疗效果。Objective To summarize the outcomes of robotic-assisted surgical system for congenital intestinal malrotation(CIM).Methods From August 2020 to June 2021,15 CIM neonates underwent robotic-assisted surgery.The relevant clinical data、Surgery-related data,postoperative recovery were collected retrospec-tively.By analyzing the preoperative,intraoperative and prognosis of the children,The robotic-assisted surgical system for congenital intestinal malrotation was summarized.Results Of the 15 children,13 were male and 2 female;gestational age 36^(+2)to 40^(+4)weeks;2 premature infants,13 term infants;7 caesarean section,8 vaginal delivery;operation age(11.7±5.9)d;weight(3065±377)g;Preoperative ultrasound test showed that 7 cases with volvulus 720,5 cases with volvulus 540,3 cases with volvulus 360;12 cases with biliary vomiting,3 cases with non-biliary vomiting;4 cases with combined atrial septal defect,2 cases with complicated patent artery duct,2 cases with combined ventricular septal defect and the remaining 7 cases without cardiac malformation。All of them underwent robotic-assisted procedures without any conversion into open surgery.The average operative duration was(57±8)min,the average system installation time(14±3)min,the average intraabdominal pressure(IAP)(5.6±0.3)mmHg and the average end-tidal carbon dioxide(38.4±4.3)mmHg.The intra-operative bleeding volume was from 1 to 3 ml,the average mechanical ventilation time(5.2±1.8)hours,the average Initial oral feeding time(3.1±1.2)days,the average sufficient feeding time(7.2±1.8)days and the average hospitalization time(12.1±2.7)days.One child was re-operated due to an obstruction of focal intestinal adhesion.Another case was hospitalized for 27 days and it was significantly longer than other children due to abnormal intestinal motility.The remainders recovered well with no postoperative complications such as vomiting,abdominal distension or incision infection.During postoperative follow-ups,all of them were well fed with satisfactory surgical incision h

关 键 词：机器人手术 十二指肠梗阻 外科手术 婴儿 新生 

分 类 号：R726.5[医药卫生—儿科]